J-1 Visa Waiver Application Instructions
General Instructions
The J-1 Visa Waiver Applicant and Employer must provide information for all sections and subsection headings outlined below and order them in the completed application as they appear in the Application Package Content and Order listing below. Print or stamp the applicant physician's review or case number from the United States Department of State (DOS) on all application pages.
J-1 Visa Waiver Application Package Content and Order
1. Letter - Submit a letter signed by the administrator of the sponsoring employer for which the applicant physician will be employed to
include the following:
a. Copy of a valid contract of employment signed and dated between the J-1 Visa Waiver applicant physician and the
sponsoring health facility. The contract must include the following:
States the applicant and employer will provide services to a caseload that is comprised of at least 30% Medicaid (Medi-Cal) patients or a 30% caseload comprised of a combination of Medi-Cal and uninsured patients throughout the three year contract period
States the practice site(s) address and county. If there are multiple practices sites, list each site with the address and days and hours at each site
b. Copy of the health facility’s federally designated Health Professional Shortage Areas (HPSA), Medically Underserved
Areas/Populations (MUA/MUP) status or Health Professional Shortage Areas (MHPSA) status for psychiatrists
for all sites where the applicant physician will or might be providing services
c. Documentation from the local health care official (county health officer/director) stating the need for services of the applicant physician
d. Evidence of recruitment and retention efforts during the past year made to American candidates for the same position the health
facility intends to fill with a foreign applicant physician (e.g., copies of advertisements, agreements with placement services, flyers
for health fairs, etc., all with dates clearly identified).
2. Information required from the J-1 Waiver applicant physician:
a. Copy of the completed Waiver Review Application Data Sheet (form DS-3035)
b. Copy of The DOS File Number Notification (aka third party barcode page) and the DOS case number must appear on every page
submitted with the application
c. Physician curriculum vitae (CV) that includes physician's name, address, date of birth, and city and country of birth
d. Letters of recommendation for J-1 Visa Waiver applicant physician
e. Copy of passage of examinations required by U.S. Citizenship and Immigration Services (USCIS): either Flex parts I and II OR all 3
steps of the United States Medical Licensing Examination (USMLE)
f. Legible copy of California medical license OR a copy of the application to the Medical Board of California AND evidence of receipt
by the Medical Board of California
g. Legible copies of all DS-2019 (formerly IAP-66) of the applicant physician covering every period (year) he/she was J-1 Visa status.
Forms must be submitted in chronological order with the "Beginning a new program" first
h. Legible copies of I-94 of applicant physician and his/her family members (front & back)
i. Four (4) separate attestations, signed and notarized (notary must include jurat verbiage. Please refer to Notary Handbook 2015
for acceptable jurat verbiage):
- An attestation that the J-1 Visa Waiver applicant of his/her requirement to provide services to a caseload that is comprised of at least 30% Medicaid (Medi-Cal) patients or a 30% caseload comprised of a combination of Medi-Cal and uninsured patients throughout the three year contract period. The sponsoring employer and J-1 Visa Waiver applicant physician must sign
- An attestation or statement of "No Objection": The applicant physician must submit a copy of a statement of no objection from their home government if he/she is contractually or financially obligated to return to the home country. In the event that the applicant physician is NOT contractually or financially obligated to return to the home country, the applicant physician must submit a signed and notarized attestation to that effect
- An Attestation from the J-1 Visa Waiver applicant physician that he/she has not other waiver request pending with another government agency
- An attestation from the J-1 Visa Waiver applicant physician of his/her commitment to comply with J-1 Visa Waiver requirements
3. California Authorization for Release of Information (PDF) form with an original signature by the applicant physician. The applicant
must identify the attorney, employer, or other designated recipient to discuss his/her J-1 Visa Waiver application
4. Federal G-28 or letter if represented by an attorney.
J-1 Visa Waiver Application Packaging
- Applications must be submitted in the order described above, separated by a tab divider page, and appropriately labeled with the name of the document.
- Submit two unbound single-sided copies of the complete application (one original, one copy) to the J-1 Visa Waiver Program.
- Do not include documents that are not required by DOS or the California J-1 Visa Waiver program.
- Applications are to be submitted to the J-1 Visa Waiver Program according to the instructions above. Please note that the Department will begin accepting applications on October 1st of each year. If October 1st falls on a weekend, applications will be accepted on the first business day following October 1st. Only applications received on or after the starting date will qualify for review and consideration.
- Each application must be shipped seperately. Shipments that contain more than one application will be returned.
Courier Mail
Primary, Rural, and Indian Health Division
Attention: J-1 Visa Waiver Coordinator
1500 Capitol Avenue, MS 8502
Sacramento, California 95814
|
United States Postal Service (USPS)
Primary, Rural, and Indian Health Division
Attention: J-1 Visa Waiver Coordinator
P.O. 997413, MS 8502
Sacramento, CA 95899-7413
|
Return to the J-1 Visa Waiver Home Page
Return to the Primary, Rural, and Indian Health Home Page